How to respond to inflamed thumb joint?

[Mellowgrover]

Hi all, I've been reading on here since I developed PMR in April this year and found the experience of others really helpful. My GP and I made the diagnosis (I'm a retired GP) and I have a first rheumatology appointment in September. I've managed to reduce from prednisolone 15mg to 11mg which I've been on about 2-3 weeks now. My symptoms have all been typical big muscle pain in hips and shoulders, plus fatigue, only one short flare since on steroids. Until 3 days ago when I noticed pain in my right thumb then swelling of the IP joint in the middle of the thumb. No other joints affected, not injured, and as I'm right handed it's awkward as quite painful to use for anything. I'll see if I can get a GP phone consultation today but wondered if in your experience this can happen in PMR and would respond to a brief increase in prednisolone? Many thanks.

[DorsetLady PMRGCAuk volunteer]

Hi and welcome…

Found this with a quick search - so not convinced it’s PMR related as such-

Several conditions can lead to pain in the IP joint of the thumb. But the most common reason is arthritis, an umbrella term used to refer to swelling and inflammation of the joints. Three types of arthritis tend to cause pain in the IP joint of the thumb: OA, PsA, and RA.

Although Pred may help the inflammation side of things you need to know what is the cause… and treat according… good old paracetamol might help pain..and icing might help inflammation. Don’t really want to increase Pred as a ‘just in case’ .. not something we would recommend..

On the newbie front - maybe have a look at this- and would suggest you may have reduced too quickly - hence the flare -

healthunlocked.com/pmrgcauk...

[Mellowgrover in reply to DorsetLady]

Thankyou, it's a bit puzzling as it's definitely an acute arthritis and I don't have any of those types of arthritis, RA was excluded by the tests I had in April. I'm going to try ice and antiinflammatory gel as I'm not keen to take more prednisolone if I can avoid it. I am trying to go carefully with reduction (slower than the current medical guidelines) and won't reduce now until this thumb settles. The flare I had was due to my PTSD getting triggered so got very anxious for a couple of days and then woke up with pain and stiffness again. That was a lesson, if it happens again I think I'll need a brief increase in steroids when I'm stressed but hard to know how much. Feels like such a long way to go to get well.....

[DorsetLady PMRGCAuk volunteer in reply to Mellowgrover]

Welcome to the wonderful confusing world of PMR….😏. Agree you don’t want to use Pred as a general painkiller - that’s not what it’s for.

As for guidelines - that’s all they are, and for some they work fine, but certainly not for everyone. Plus it does say tapering should be adjusted to individual circumstances.

Usual flare protocol we suggest is included in this link….but you may find you don’t need to follow that every time - but what we would say is, try not to get into a yo-yoing situation, it might help at the time… but in the long term it’s not a good idea. Apt to confuse the body even more.

Ideally, try and avoid stressful situations, PMR just loves stress, but as we all know that not a reality, so you have to learn to manage it as best you can - but I’m sure you’re well aware of that and all the appropriate strategies.

healthunlocked.com/pmrgcauk...

[Sillydogsmum]

Why not try Ibuprofen gel or similar for a couple of days ?

[Mellowgrover in reply to Sillydogsmum]

Yes I was thinking of trying that, thanks

[Sillydogsmum in reply to Mellowgrover]

Worked a treat on my prepatellar bursitis that appeared after a fairly ordinary mornings weeding.........autoimmune potentiated inflammatory reaction I presume!

[Tarym in reply to Mellowgrover]

Flexiseq works for my thumb joints

[Orange_2022 in reply to Tarym]

Mine too - it's great!

[Mellowgrover in reply to Tarym]

Thanks, I will give that a go.

[random901]

Hi Mellowgrover! Currently on 12.5 pred, diagnosed Oct 23, and recently getting pains in fingers & thumb, particularly RHS (I'm right-handed.) As knitting and gardening are my chief occupations, this is a most unwelcome development. I find any kind of gentle massage and gentle stretching help, with any cream but the magnesium one is good.

[Mellowgrover in reply to random901]

Thanks. It certainly is unwelcome, as it's also my right dominant hand and I'm having an interesting time trying things left handed, to say the least. As it's just flared up I'm hoping it can settle down just as fast.

[Stills]

I do not have PMR, my diagnosis is AOSD 1979 aged 17 now 62 and major drug free. I wake each morning with a small joint swelling, very painful and often looks red. I find heat helps quite a lot and the joint returns to normal as much as possible (DC) within a few hours. This is not restricted to morning and can come on at any time and is usually associated with headache sore throat and fever typical of Stills. I know certain foods trigger these small joints attacks and I think for me it’s flour.

Edit: I’m a reader here as many symptoms overlap and the advice is better for me than the arthritis site.

[Mellowgrover in reply to Stills]

Thanks, that's interesting. I hope you can nail down the triggers for your attacks and exclude them, might need a food diary by the sound of it. I think the inflammation in PMR might be generated a different way to Stills but I will have a think about what I did just before it came on in case I can identify a trigger.

[Stills in reply to Mellowgrover]

Wishing you good days

[Almostaweed]

My experience when I was on levels of Pred between 15mg and 8mg (approx) was that the PMR pain seemed to end up in my wrists and ankles, as though the inflammation had got pushed to my extremities. The worst of this wore off as I reduced from about 8mg although I still have a feeling of stiffness in my ankles. I don't know if this has any relevance to your experience with your thumb. My view is that Pred is sometimes the culprit and it is important to reduce it (GRADUALLY AND SAFELY OF COURSE - DON'T WANT TO END UP IN A&E AS I DID) to a level where it keeps PMR at bay but causes least harm.

[AtopicGuy]

Is the problem definitely in the joint, or in the tendons and structures that allow them to slide? As you know, there's one that bends the thumb and another to straighten it.

[Mellowgrover in reply to AtopicGuy]

I'm sure it's the joint, it's tender along the joint line and swollen all around it, and I can't fully flex it. Trying to find time to read the medical literature about small joint involvement in PMR to see if it is related.

[AtopicGuy in reply to Mellowgrover]

If it's autoimmune arthritis, it's odd that it should emerge after you've started on steroids. The aetiology of PMR is theorised to be autoimmune inflammation of blood vessels serving major skeletal muscles (largely based on its close association with GCA).

[Mellowgrover in reply to AtopicGuy]

Yes it seems unlikely to be another condition emerging and looking at some more detail there are consistent reports of both synovitis and tenosynovitis (inflammation of the joint lining or tendon sheath) seen on MRI in PMR. It could be a kind of mini-flare, I did get stressed a couple of days before it came on, and that's my Achilles heel because I have PTSD so I think it soaks up all my steroids when it's triggered. And I have changed my life around to avoid stress but I can't control everything.Anyway thanks for your interest and I hope you are keeping well.

[NCStateLine]

I have the same issue and Rheumy recommended Voltaren gel diclofen) and it works very well. It is a NSAID.

[Mellowgrover in reply to NCStateLine]

Thanks that's helpful. I'm using ibuprofen gel as it's what I have but voltarol is a bit stronger so may graduate to that. My first rheumatology appointment has come through at last, early September. Did your rheumy think it was the PMR causing it?

[NCStateLine in reply to Mellowgrover]

Nope - I had pre-existing RA a base of left thumb that felt better at high pred but as pred dose dropped from 20 eventually down to 4.5 currently - the thumb started hurting more. The Rheumy said that the Voltaren would help and it does. The generic is diclofenac which is about half the price

[Sandmason]

I have OA in my hands, ruined thumb joints. My PMR flared into my hands and wrists in January. I went to my hand and wrist ortho after I got signs of carpal tunnel, which is common in PMR. The back of my thumb joint had a big swelling. So he did a Kenalog injection using ultrasound. It immediately got better.

Funny my own GP refused to diagnose PMR, while my retired Internist husband diagnosed me, lol. I just switched to Direct Primary Care, in the US it's a huge relief for both doctors and patients, $99 a month for as much or as little care as you need. The new doc is perfectly comfortable with PMR, he knows of my husband's excellent reputation, and I can walk away from an ignorant doctor.

[Mellowgrover in reply to Sandmason]

I have got good support from my GP, and glad you have found the right care in the end. I have GP review in 2 weeks and specialist in September so hoping I'll get help, in the meantime I have gone back to my GP online and should get prescription and advice tomorrow.

[PMRpro Ambassador]

Hi and welcome - belatedly from me but I'm catching up after being away for a funeral.

PMR isn't really the name of the disease, it is the name of a constellation of symptoms and as I'm sure you know, there are several potential underlying causes in the differential diagnosis. PMR as we talk about it is probably an autoimmine disorder but it is increasingly clear that it isn't a single simple benign syndrome! However, besides "our"PMR, there are several inflammatory arthritides that can have a purely polymyalgic presentation and that includes RA and ankylosing spondylitis, especially in late onset cases, and a reactive arthritis or palindromic rheumatism. Even with the usual RA testing, they may not be apparent and neither does absence mean it isn't them! We have had people on the forums who have later been diagnosed with all those I have named - and even the top GCA bod in the UK was fooled by a case of AS which caused GCA-type tongue symptoms! It was a throw-away comment about noctural back pain that rang a bell for Prof Sarah Mackie and she found AS with an MRI in a middle aged patient with no other apparent signs or symptoms, just PMR.

Many patients are told they have an "atypical" PMR - but to us their presentation sounds very typical. However - some apparently typical cases of PMR aren't.

[Mellowgrover]

Thanks, and yes it's complicated isn't it! Hopefully I will be a bit clearer after my rheumatology appointment. Btw In my medical training 35 years ago I was taught to try 30mg prednisolone and if it worked I had cured them! No one mentioned the long slow slog to manage it, trying to retain some fitness, stay safe without your own body's endocrine response to stress or illness, and the need for rehab/pacing support which still seems not to exist........

[DorsetLady PMRGCAuk volunteer in reply to Mellowgrover]

Cured them ? We wish .. 😳 unfortunately 30 years on, some still have that view.

“Manage” should be the new byword -at least it is on here…

[PMRpro Ambassador in reply to Mellowgrover]

"Cured" - if only!!! And don't build your hopes up too much about the consultant appointment because some of them don't get it at all! A good GP is often preferable to a poor rheumy who is trying to force you to reduce the pred at speed - rather than tapering or titrating the dose VERY slowly. And there is a big difference.

The support you will get here - because we DO "get it" and we also work closely with top experts in the field. My own rheumy in Italy is considered to be THE world leader in the field by the top UK PMR rheumy, Prof Sarah Mackie in Leeds.

[piglette in reply to Mellowgrover]

I reckon getting a good rheumi or any doctor if it comes to that is a game of Russian roulette! Having read this board for some time, some are REALLY bad and some are REALLY good. The game is to find the right one!